Salt Toxicity: A Systematic Review and Case Reports.

INTRODUCTION: Salt toxicity is a rare form of hypernatremia that typically occurs after a single massive ingestion of salt over a short period of time (minutes/hours). It is a dangerous imbalance capable of causing significant neurological injury; quick recognition of salt toxicity is crucial to allow treatment before permanent brain injury occurs. The purpose of this review is to assist emergency nurses in gaining knowledge on the causes, pathophysiology, symptoms, and treatment of salt toxicity. METHODS: A systematic search for case reports of hypernatremia due to salt toxicity was conducted in the PubMed and Scopus electronic databases. The search terms used were salt, sodium, hypernatremia, toxicity, poisoning, case reports, case series, and cases. The following were the inclusion criteria: publication dates between January 1, 2000, and September 30, 2019; evidence of an acute large oral or gastric tube ingestion of salt over a short period of time (minutes/hours); admission for treatment within hours of the event; laboratory verification of hypernatremia; and full-text article available electronically in English. The following were the exclusion criteria: an unclear history, high salt consumption over a period of days, high sodium intake via the intravenous route, and breast feeding. RESULTS: Only 15 cases met the inclusion criteria for the review. Patients described in the case reports ranged in age from 5 days to 73 years. Forty percent of the patients were children less than 15 years old. Of the 14 cases with known outcomes, 50% were fatal. The most frequent causes of salt toxicity were salt water emetics, intentional administration of large quantities of salt to a child by a caregiver, and suicide attempts. Among the other causes were unintentional salt overload in infant formula, an exorcism ritual, and a college prank. DISCUSSION: Findings from this review of 15 case reports in which a large salt load was ingested over a short period of time suggest that salt toxicity is a rare condition associated with high mortality. In addition, salt toxicity can occur in patients of all ages for a variety of reasons; the most frequently identified reasons in this review were use of salt water as an emetic and child abuse by the intentional administration of a high salt load by a caregiver. For patients whose massive exposure to salt is recent (such as minutes to hours), rapidly reducing the serum sodium concentration may prevent irreversible neurological injury.

A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes.

The purpose of this review was to (1) identify areas of agreement and disagreement in guidelines/recommendations to distinguish between gastric and pulmonary placement of nasogastric tube and (2) summarize factors that affect choices made by clinicians regarding which method(s) to use in specific situations. Systematic searches were conducted in the PubMed, Scopus, and CINAHL Plus databases using a combination of keywords and data-specific subject headings. Searches were limited to guidelines/recommendations from national level specialty groups and governmental sources published in the English language between January 1, 2015 and September 20, 2018. Fourteen guidelines that described methods to distinguish between gastric and pulmonary placement of nasogastric tubes were identified from a variety of geographic locations. Tube placement testing methods included in the review were: radiography, respiratory distress, aspirate appearance, aspirate pH, auscultation, carbon dioxide detection and enteral access devices. All fourteen guidelines agreed that radiography is the most accurate testing method. Of the nonradiographic methods, pH testing was most favored; least favored was auscultation.

Survivor Notification of Post-Disaster Mental Health Services: An Integrative Review.

This integrative review identifies notification methods for psychiatric mental health services for adult survivors of natural disasters for articles published from 2011 through 2016. Databases searched included Scopus, Cochrane Library, CINAHL Plus, Ovid MEDLINE, and Ovid PsycINFO. The search was limited to English language. Initially, 273 titles/abstracts were reviewed, and 18 articles were retained for synthesis. Communication occurs through formal means of health care provider referrals and online programs (72%); informal supports are friends, family and clergy (28%). Mental health providers have significant impact on disaster recovery by developing plans for communication.

Motivational Interviewing and Fruit/Vegetable Consumption in Older Adults.

Evidence supports the relationship between fruit and vegetable consumption (FVC) and risk reduction for several illness conditions, even for older adults. Thus, we examined the effects of motivational interviewing (MI) on FVC in adults with a mean age ≥60. We chose MI because of its growing popularity as an effective behavior change strategy and because the person-centered MI principles are a good fit for older adults. We searched 10 electronic databases, several journals, and unpublished and fugitive literature. We retrieved seven primary studies, providing nine comparisons, with 1,978 participants. The overall MI effect size (ES) was .221 ( p = .002). When the percentage of women was greater, ES was lower; when interventionists had more training, ES was higher; and when sessions were longer, ES was stronger. Future researchers might test longer sessions with trained interventionists and examine gender differences. Practitioners should be well trained and offer sessions that are 30 to 40 min in length.

Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors.

CONTEXT: Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia. OBJECTIVE: To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors. DATA SOURCES: Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015. STUDY SELECTION: Inclusion criteria were determined a priori and included original research with participants' pain diffuse, located in the posterior medial tibial region, and activity related. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I2 index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality. RESULTS: Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity. CONCLUSION: Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.

The Mobile Reference Service: a case study of an onsite reference service program at the School of Public Health.

The School of Public Health at Saint Louis University is located at a greater distance from the library than other programs on the main medical center campus. Physical distance diminishes the ease of access to direct reference services for public health users. To bridge the gap, the library developed the Mobile Reference Service to deliver on-site information assistance with regular office hours each week. Between September 2006 and April 2007, a total of 57 in-depth reference transactions took place over 25 weeks, averaging 2 transactions per week in a 2-hour period. Overall reference transactions from public health users went up 28%, while liaison contacts with public health users doubled compared to the same period the year before. The Mobile Reference Service program has improved library support for research and scholarship, cultivated and strengthened liaison relationships, and enhanced marketing and delivery of library resources and services to the Saint Louis University School of Public Health.

An exploratory analysis of PubMed's free full-text limit on citation retrieval for clinical questions.

OBJECTIVE: The research sought to determine (1) how use of the PubMed free full-text (FFT) limit affects citation retrieval and (2) how use of the FFT limit impacts the types of articles and levels of evidence retrieved. METHODS: Four clinical questions based on a research agenda for physical therapy were searched in PubMed both with and without the use of the FFT limit. Retrieved citations were examined for relevancy to each question. Abstracts of relevant citations were reviewed to determine the types of articles and levels of evidence. Descriptive analysis was used to compare the total number of citations, number of relevant citations, types of articles, and levels of evidence both with and without the use of the FFT limit. RESULTS: Across all 4 questions, the FFT limit reduced the number of citations to 11.1% of the total number of citations retrieved without the FFT limit. Additionally, high-quality evidence such as systematic reviews and randomized controlled trials were missed when the FFT limit was used. CONCLUSIONS: Health sciences librarians play a key role in educating users about the potential impact the FFT limit has on the number of citations, types of articles, and levels of evidence retrieved.

Journal publication productivity in academic physical therapy programs in the United States and Puerto Rico from 1998 to 2002.

BACKGROUND AND PURPOSE: The peer-reviewed journal article is the basic unit by which scholarship is defined. Few studies have examined peer-reviewed publication productivity in academic physical therapy programs. In this study, the publication productivity in academic physical therapy programs in the United States and Puerto Rico from 1998 to 2002 was documented, and publication productivity was examined in the context of selected program characteristics. SUBJECTS AND METHODS: A total of 194 programs listed on the Commission on Accreditation in Physical Therapy Education (CAPTE) Web site in the spring of 2004 were examined. The databases were searched for bibliographic citations of journal articles attributed to particular programs. The program characteristics of faculty size, offering of a research doctorate, and listing in the Carnegie Classification of Institutions of Higher Education (Carnegie Classification) were compared with the number of citations. RESULTS: A total of 169 programs had at least 1 attributed citation, 50.3% of the programs had fewer than 5 citations, and 3% had 44 or more citations. Rankings based on the number of citations changed when adjusted for faculty size. Of the 38 programs offering a research doctoral degree, 16 had 20 or more citations. Five programs with 44 or more citations were all categorized by the Carnegie Classification as doctoral intensive or extensive. DISCUSSION AND CONCLUSION: A few programs had a large number of attributed bibliographic citations, but the majority of programs had limited publication productivity in the 5 years studied. These results may provide a baseline for studying the effectiveness of the relatively new CAPTE standards mandating scholarship by physical therapy faculty over time and the impact of the Doctor of Physical Therapy degree on research in physical therapy.

Development and evaluation of evidence-based nursing (EBN) filters and related databases.

OBJECTIVES: Difficulties encountered in the retrieval of evidence-based nursing (EBN) literature and recognition of terminology, research focus, and design differences between evidence-based medicine and nursing led to the realization that nursing needs its own filter strategies for evidence-based practice. This article describes the development and evaluation of filters that facilitate evidence-based nursing searches. METHODS: An inductive, multistep methodology was employed. A sleep search strategy was developed for uniform application to all filters for filter development and evaluation purposes. An EBN matrix was next developed as a framework to illustrate conceptually the placement of nursing-sensitive filters along two axes: horizontally, an adapted nursing process, and vertically, levels of evidence. Nursing diagnosis, patient outcomes, and primary data filters were developed recursively. Through an interface with the PubMed search engine, the EBN matrix filters were inserted into a database that executes filter searches, retrieves citations, and stores and updates retrieved citations sets hourly. For evaluation purposes, the filters were subjected to sensitivity and specificity analyses and retrieval set comparisons. Once the evaluation was complete, hyperlinks providing access to any one or a combination of completed filters to the EBN matrix were created. Subject searches on any topic may be applied to the filters, which interface with PubMed. RESULTS: Sensitivity and specificity for the combined nursing diagnosis and primary data filter were 64% and 99%, respectively; for the patient outcomes filter, the results were 75% and 71%, respectively. Comparisons were made between the EBN matrix filters (nursing diagnosis and primary data) and PubMed's Clinical Queries (diagnosis and sensitivity) filters. Additional comparisons examined publication types and indexing differences. Review articles accounted for the majority of the publication type differences, because "review" was accepted by the CQ but was "NOT'd" by the EBN filter. Indexing comparisons revealed that although the term "nursing diagnosis" is in Medical Subject Headings (MeSH), the nursing diagnoses themselves (e.g., sleep deprivation, disturbed sleep pattern) are not indexed as nursing diagnoses. As a result, abstracts deemed to be appropriate nursing diagnosis by the EBN filter were not accepted by the CQ diagnosis filter. CONCLUSIONS: The EBN filter capture of desired articles may be enhanced by further refinement to achieve a greater degree of filter sensitivity. Retrieval set comparisons revealed publication type differences and indexing issues. The EBN matrix filter "NOT'd" out "review," while the CQ filter did not. Indexing issues were identified that explained the retrieval of articles deemed appropriate by the EBN filter matrix but not included in the CQ retrieval. These results have MeSH definition and indexing implications as well as implications for clinical decision support in nursing practice.